<div class="judul_content">Tambah Data kabupaten</div>
<form class="form" name="form_tambah" action="utama.php?module=mod_kabupaten&act=simpan" method="post">
     <ul>
        <li>
            <label>Nama Kabupaten</label>
            <input type="text" name="name" id="name" class="form" maxlength="30" size="30">
        </li>
		<li>
            <label>Provinsi</label>
            <select name="provinsi" id="provinsi" class="form">
				<option value=""> - - Pilih Provinsi - - </option>
				<?php
					$provinsi = $koneksi->query("select * from provinsi order by provinsi");
					while ($p = $provinsi->fetch(PDO::FETCH_ASSOC)){
						echo "<option value=$p[id_provinsi]>$p[provinsi]</option>";
					}
				?>
			</select>
        </li>
		<li>
            <label>Tarif</label>
            <input type="text" name="tarif" id="tarif" class="form" maxlength="5" size="30">
        </li>
        <li>
            <label>&nbsp;</label>
            <input type="reset" name="reset" value="Reset" class="reset">
            <input type="submit" name="submit" value="Simpan" class="tambah">
        </li>
    </ul>
</form>       